Eryilmaz Fahri, Farooque Umar
Neurological Surgery, Hitit University Erol Olcok Training and Research Hospital, Corum, TUR.
Neurology, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2021 Mar 21;13(3):e14018. doi: 10.7759/cureus.14018.
Introduction Cervical myelopathy (CM) is caused by degenerative or congenital changes in the discs and soft tissues of the cervical spine, leading to chronic compression of the spinal cord. The current treatment for moderate-to-severe CM is surgical decompression, which is effective in most cases; however, it can cause inflammation of the nervous system and spinal cord reperfusion injury, resulting in perioperative neurological complications and suboptimal neurological recovery. The aim of this study was to investigate the therapeutic effects of the combination of erythropoietin and methylprednisolone in the treatment of ischemia-reperfusion injury to the spinal cord and to analyze its effects on the levels of interleukin-1 beta (IL-1β), interleukin-1 receptor antagonist (IL-1RA), and interleukin-8 (IL-8). Materials and methods This study included 110 patients admitted to the hospital due to cervical spondylotic myelopathy. They were randomized into two groups of 55 patients each: a control and an observation group. In both groups of patients, fusion internal fixation and anterior cervical discectomy were performed. The difference, however, was that the control group received a rapid intravenous injection of 30 mg/kg methylprednisolone 30 minutes prior to spinal cord decompression, while the observation group received an intravenous injection of 30 mg/kg methylprednisolone and 3,000 U/kg erythropoietin 30 minutes before spinal cord decompression. The study was approved by the Hospital Ethical Committee of the Dow University of Health Sciences, Karachi. The neurological function of both groups of patients was assessed before the procedure and three months after the treatment using the Japanese Orthopedic Association (JOA) method of assessing spinal cord function (40-point rating method). Enzyme-linked immunosorbent assay (ELISA) was performed to measure the levels of neuron-specific enolase (NSE), S-100β, IL-1RA, IL-1β, and IL-8 in both groups. The quality of life of patients in both groups was assessed three months after the treatment with the World Health Organization Quality of Life assessment instrument (WHOQOL-100). Results Before the treatment, there was no significant variance between the two groups in the JOA score and the 40-point rating method. Similarly, there was no significant difference in the levels of IL-1β, IL-1RA, and IL-8 between the two groups (p-value = 0.262, 0.387, and 0.154 respectively) prior to the treatment. Three months after the treatment, the levels of IL-1β and IL-8 in the observation group were 21.83 ±3.65 ng/l and 357.07 ±32.36 ng/l respectively, both lower than the control group value (p-value = 0.026, 0.028 respectively). The level of IL-1RA in follow-up was 21.59 ±1.15 ng/l, which was higher than that in the control group. Three months after the treatment, all the WHOQOL-100 parameters of the observation group for psychology, physiology, social relations, independence, spirituality, environment, and general quality of life were higher than those of the control group; the variance among the groups was statistically significant (p-value: <0.001). Conclusions The combination therapy with erythropoietin and methylprednisolone is effective for ischemia-reperfusion injuries of the spinal cord. It also reduces S-100β and NSE, inhibits IL-1β, and increases IL-8 and IL-1RA. Therefore, it preserves and improves spinal nerve function and the quality of life of patients.
引言
脊髓型颈椎病(CM)是由颈椎间盘和软组织的退行性或先天性改变引起的,导致脊髓慢性受压。目前中重度CM的治疗方法是手术减压,大多数情况下是有效的;然而,它可能会引起神经系统炎症和脊髓再灌注损伤,导致围手术期神经并发症和神经功能恢复不理想。本研究的目的是探讨促红细胞生成素和甲基强的松龙联合治疗对脊髓缺血再灌注损伤的疗效,并分析其对白细胞介素-1β(IL-1β)、白细胞介素-1受体拮抗剂(IL-1RA)和白细胞介素-8(IL-8)水平的影响。
材料与方法
本研究纳入了110例因颈椎病脊髓型入院的患者。他们被随机分为两组,每组55例:对照组和观察组。两组患者均行融合内固定和颈椎前路椎间盘切除术。然而,不同之处在于对照组在脊髓减压前30分钟快速静脉注射30mg/kg甲基强的松龙,而观察组在脊髓减压前30分钟静脉注射30mg/kg甲基强的松龙和3000U/kg促红细胞生成素。本研究经卡拉奇道健康科学大学医院伦理委员会批准。两组患者在手术前和治疗后三个月使用日本骨科协会(JOA)评估脊髓功能的方法(40分评分法)评估神经功能。采用酶联免疫吸附测定(ELISA)法检测两组患者神经元特异性烯醇化酶(NSE)、S-100β、IL-1RA、IL-1β和IL-8的水平。两组患者在治疗三个月后使用世界卫生组织生活质量评估工具(WHOQOL-100)评估生活质量。
结果
治疗前,两组患者的JOA评分和40分评分法无显著差异。同样,治疗前两组患者的IL-1β、IL-1RA和IL-8水平也无显著差异(p值分别为0.262、0.387和0.154)。治疗三个月后,观察组的IL-1β和IL-8水平分别为21.83±3.65ng/L和357.07±32.36ng/L,均低于对照组(p值分别为0.026、0.028)。随访时IL-1RA水平为21.59±1.15ng/L,高于对照组。治疗三个月后,观察组在心理、生理、社会关系、独立性、精神、环境和总体生活质量等所有WHOQOL-100参数均高于对照组;组间差异具有统计学意义(p值:<0.001)。
结论
促红细胞生成素和甲基强的松龙联合治疗对脊髓缺血再灌注损伤有效。它还能降低S-100β和NSE,抑制IL-1β,并增加IL-8和IL-1RA。因此,它能保留并改善患者的脊髓神经功能和生活质量。